DALLAS — Now that the shouting from August’s town hall meetings has died down and Congress has made progress on a health care overhaul, there’s growing agreement among policy experts about how Medicare will be affected.

The 10.4 million beneficiaries with private insurers’ Medicare Advantage plans will still get coverage at least comparable to regular Medicare, but some will see fewer extra benefits or higher out-of-pocket costs.

For most of Medicare’s 45 million beneficiaries, an overhaul will improve coverage by beefing up drug benefits, preserving access to physicians, paying for more preventive care and putting Medicare on firmer financial footing.

“Lies were spread this summer, and many seniors were misled,” said Lynda Ender, director of advocacy for the Senior Source, a nonprofit agency that serves older adults in Dallas. “I’m hopeful about health care reform. I see a lot of good coming out of it for people on Medicare.”

Ender said she was flabbergasted this summer when she heard seniors and others vehemently oppose any “public option” insurance plan but at the same time demand that lawmakers keep their hands off Medicare.

“Don’t they realize that the traditional Medicare program is public insurance?” she said.

After a summer of rhetoric and rumors, an Associated Press poll found that the opposition to a health care overhaul had reached 59 percent among older adults, as many worried that Congress would force them to pay more for less.

Mary Frances Hansen, 72, of Frisco, Texas, said she has been pleased with her private Medicare Advantage plan’s $5 to $25 co-payments, so she fears what might happen to that coverage if the current health care proposals pass.

“I want everyone to have health care, but this country isn’t treating seniors well,” she said. “I’m skeptical of reform.”

To reassure seniors, the Obama administration, congressional Democrats and organizations such as AARP launched campaigns this fall emphasizing that an overhaul will help, not hurt, most Medicare beneficiaries.

Seniors’ opposition has fallen to 43 percent in the latest AP poll.

Mary Watkins, 80, of Dallas, said she is rooting for Congress and the White House to enact a law this year because she’s convinced they can wring enough wasteful spending from the health care system to pay for the uninsured.

Though she’s usually been satisfied with her Medicare coverage, she knows of younger families on her street who lack insurance and complain about sitting for hours at hospitals or clinics before seeing a doctor.

“If dollars were better spent, there’d be money to care for both me and my neighbors,” she said.

Those worried that Medicare beneficiaries will suffer from a health care overhaul have focused on the $500 billion that will be trimmed from the $6.4 trillion expected to be spent on Medicare over 10 years.

Part of that $500 billion will come from more aggressively attacking waste and fraud, while other savings will come from giving providers such as hospitals and home health care agencies less of an increase each year.

The nation’s hospitals agreed this summer to contribute $155 billion over 10 years toward the cost of insuring the uninsured, about $100 billion of which will come from lower-than-expected Medicare and Medicaid payments.

With more patients insured, hospitals are banking on less uncompensated care. Though they won’t receive as much as they had hoped to treat Medicare patients, the hospitals will now get paid for previously uninsured younger patients.

“When budget experts talk about $500 billion in cuts from Medicare, they aren’t necessarily referring to cuts that will compromise beneficiaries’ access to services,” said Edwin Park, a senior fellow at the Center on Budget and Policy Priorities, a nonpartisan research institute.

“In many cases, it has more to do with slowing the growth in spending.”

The most controversial savings are the proposals to scale back the government’s payments to insurers such as Humana Inc. and UnitedHealth Group Inc. for covering beneficiaries enrolled in private Medicare Advantage plans.

“That will hurt seniors,” said John Goodman, president and chief executive of the free-market-oriented National Center for Policy Analysis in Dallas. “Many will face fewer benefits and higher out-of-pocket expenses, and many will have fewer plans to choose from.”

“There was a reason why many of the people at the town hall meetings had white hair. They knew what a bad deal this is.”

The private Medicare Advantage plans often cover services, like dental or vision care, that go beyond those included in Medicare’s traditional fee-for-service program, and the extra benefits have lured many people away from original Medicare.

But those extra benefits have their price. The private plans, originally intended to save taxpayers money, have ended up costing Medicare more, said Joe Baker, president of the Medicare Rights Center, a consumer advocacy group.

The government spends 14 percent more to cover beneficiaries through the private plans than it would through Medicare’s traditional program, says the Medicare Payment Advisory Commission, an independent congressional agency. That breaks down to an additional $1,100 per Medicare Advantage enrollee per year.

Baker acknowledges that curbing the overpayments by more than $100 billion over 10 years might compel insurers to cut some perks or increase enrollees’ out-of-pocket costs, but he suggests the plans could offset the loss of revenue by becoming more efficient.

Though Medicare Advantage plans may be forced to look for cost savings because of smaller government payments, Medicare’s traditional fee-for-service program will see improved benefits.

“The big untold story here is the money that will be plowed back into Medicare as a result of a health care overhaul,” said David Certner, legislative policy director for AARP.

The overhaul legislation calls for up to $272 billion to be reinvested in the program over the next decade.

Many of the 3.4 million beneficiaries who have high enough expenses to reach the “doughnut hole” in Medicare’s prescription drug benefit will get help from the health care bills working their way through Congress, he said.

Those beneficiaries now pay the full price of their prescriptions in the coverage gap, which begins when their total drug costs reach $2,700 and ends when those expenses pass $6,154. They then pay just 5 percent of the costs.

Both the Senate Finance Committee bill and the House bill give Medicare beneficiaries a 50 percent discount on brand-name drugs bought in the doughnut hole. The House bill also shrinks and eventually eliminates the gap.

“We get calls all the time on our consumer hot line from seniors and others who must skip doses, split pills or forgo medications because of the high cost of drugs in the coverage gap,” Baker said. “This part of health care reform should ease their burden.”

Promoting preventive care is another key element.

In recent years, Medicare has begun paying for a broad range of screenings to catch problems early. The overhaul bolsters that effort by waiving out-of-pocket costs for preventive services that Medicare now only partially covers, Baker said.

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